A community-based epidemiological survey of female urinary incontinence. The Norwegian EPINCONT study

Aims of study
The aim of the study was to assess the prevalence of any urinary leakage in an unselected female population in Norway, and to estimate the prevalence of significant incontinence.

Methods
The EPINCONT Study is part of a large survey (HUNT 2) performed in a county in Norway during 1995-97. All citizens aged 13 years or more (appr. 100.000) were invited. The complete survey covered many topics. A mailed questionnaire was part of the invitation. Clinical and laboratory tests were performed at the screening-station and the participants received a second questionnaire (this time containing questions about urinary leakage), which was to be returned by mail.

27936 (80%) out of 34755 participating community-dwelling women aged 20 years or more, answered our questions about frequency and severity of urine loss, type of incontinence, the duration of the condition, whether a doctor had been consulted on this matter, and to what extent the urinary leakage was experienced as a problem. A validated severity index was used to assess severity (1,2(.

Results
25% of the participating women had urinary leakage (n=6876). Nearly 7% had significant incontinence, defined as moderate or severe incontinence that was also experienced as bothersome. The prevalence of both any incontinence and significant incontinence increased with increasing age (fig. 1). Half of the incontinent women were experiencing symptoms of stress type incontinence alone. Symptoms of urge incontinence alone affected 11%, while mixed incontinence was stated by 36% of the cases. The fraction of stress incontinence symptoms was highest among the women between 25 and 49 years of age, and then there was some relative decrease with increasing age. The severity of incontinence varied between the different types. The fraction of severe incontinence was 17%, 28% and 38% in the stress, urge and mixed groups, respectively.

Two thirds of the incontinent women stated that their leakage was no problem or just a small nuisance while about 10% were much bothered or experienced their incontinence as a great problem. There was a significant correlation between the severity index and the rating of incontinence as a problem. The impact of incontinence differed between the types. Among women with symptoms of mixed incontinence, 47% were bothered. The corresponding figures for urge and stress incontinence were 36% and 24%, respectively. A total of 26% of the women had consulted a doctor for their leakage.

Conclusions
Urinary leakage is highly prevalent among adult women, and the prevalence is increasing with increasing age. 7% have significant incontinence, and this group should be regarded as potential patients.

References:

1. Validation of a severity index in female urinary incontinence and its implementation in an epidemiological survey. J Epidemiol Community Health 1993;47(6):497-9.
2. A severity index for epidemiological surveys of female urinary incontinence. Comparison with 48-hour pad weighing tests. Neurourol Urodyn 2000;19(2):137-145.

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Department of Public Health and Primary Health Care, last updated 14.09.00